1
|
Zhao J, Wu S, Wang D, Edwards H, Thibodeau J, Kim S, Stemmer P, Wang G, Jin J, Savasan S, Taub JW, Ge Y. Panobinostat sensitizes AraC-resistant AML cells to the combination of azacitidine and venetoclax. Biochem Pharmacol 2024; 228:116065. [PMID: 38373594 DOI: 10.1016/j.bcp.2024.116065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/22/2024] [Accepted: 02/16/2024] [Indexed: 02/21/2024]
Abstract
The majority of acute myeloid leukemia (AML) patients respond to intensive induction therapy, consisting of cytarabine (AraC) and an anthracycline, though more than half experience relapse. Relapsed/refractory (R/R) AML patients are difficult to treat, and their clinical outcomes remain dismal. Venetoclax (VEN) in combination with azacitidine (AZA) has provided a promising treatment option for R/R AML, though the overall survival (OS) could be improved (OS ranges from 4.3 to 9.1 months). Overexpression of c-Myc is associated with chemoresistance in AML. Histone deacetylase (HDAC) inhibitors have been shown to suppress c-Myc and enhance the antileukemic activity of VEN, as well as AZA, though combination of all three has not been fully explored. In this study, we investigated the HDAC inhibitor, panobinostat, in combination with VEN + AZA against AraC-resistant AML cells. Panobinostat treatment downregulated c-Myc and Bcl-xL and upregulated Bim, which enhanced the antileukemic activity of VEN + AZA against AraC-resistant AML cells. In addition, panobinostat alone and in combination with VEN + AZA suppressed oxidative phosphorylation and/or glycolysis in AraC-resistant AML cells. These findings support further development of panobinostat in combination with VEN + AZA for the treatment of AraC-resistant AML.
Collapse
MESH Headings
- Humans
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/metabolism
- Leukemia, Myeloid, Acute/pathology
- Sulfonamides/pharmacology
- Sulfonamides/administration & dosage
- Panobinostat/pharmacology
- Panobinostat/administration & dosage
- Bridged Bicyclo Compounds, Heterocyclic/pharmacology
- Bridged Bicyclo Compounds, Heterocyclic/administration & dosage
- Azacitidine/pharmacology
- Azacitidine/administration & dosage
- Drug Resistance, Neoplasm/drug effects
- Cytarabine/pharmacology
- Cytarabine/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/pharmacology
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Cell Line, Tumor
- Drug Synergism
- Antineoplastic Agents/pharmacology
- Antineoplastic Agents/administration & dosage
- Histone Deacetylase Inhibitors/pharmacology
- Histone Deacetylase Inhibitors/administration & dosage
Collapse
Affiliation(s)
- Jianlei Zhao
- National Engineering Laboratory for AIDS Vaccine, Key Laboratory for Molecular Enzymology and Engineering, The Ministry of Education, School of Life Sciences, Jilin University, Changchun 130012, PR China; Department of Oncology, Wayne State University School of Medicine, Detroit, MI 48201, USA; Molecular Therapeutics Program, Barbara Ann Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI 48201, USA
| | - Shuangshuang Wu
- Department of Pediatric Hematology, The First Hospital of Jilin University, Changchun 130012, PR China
| | - Deying Wang
- The Tumor Center of the First Hospital of Jilin University, Changchun 130021, PR China
| | - Holly Edwards
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI 48201, USA; Molecular Therapeutics Program, Barbara Ann Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI 48201, USA
| | - Jenna Thibodeau
- Cancer Biology Graduate Program, Wayne State University School of Medicine, Detroit, MI 48201, USA
| | - Seongho Kim
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI 48201, USA; Molecular Therapeutics Program, Barbara Ann Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI 48201, USA
| | - Paul Stemmer
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, Detroit, MI 48201, USA
| | - Guan Wang
- National Engineering Laboratory for AIDS Vaccine, Key Laboratory for Molecular Enzymology and Engineering, The Ministry of Education, School of Life Sciences, Jilin University, Changchun 130012, PR China
| | - Jingji Jin
- National Engineering Laboratory for AIDS Vaccine, Key Laboratory for Molecular Enzymology and Engineering, The Ministry of Education, School of Life Sciences, Jilin University, Changchun 130012, PR China
| | - Süreyya Savasan
- Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI 48202, USA; Division of Pediatric Hematology and Oncology, Children's Hospital of Michigan, Detroit, MI 48202, USA; Department of Pediatrics, Central Michigan University College of Medicine, Mt. Pleasant, MI 48859, USA
| | - Jeffrey W Taub
- Cancer Biology Graduate Program, Wayne State University School of Medicine, Detroit, MI 48201, USA; Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI 48202, USA; Division of Pediatric Hematology and Oncology, Children's Hospital of Michigan, Detroit, MI 48202, USA; Department of Pediatrics, Central Michigan University College of Medicine, Mt. Pleasant, MI 48859, USA.
| | - Yubin Ge
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI 48201, USA; Molecular Therapeutics Program, Barbara Ann Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI 48201, USA; Cancer Biology Graduate Program, Wayne State University School of Medicine, Detroit, MI 48201, USA.
| |
Collapse
|
2
|
Solana-Altabella A, Rodríguez-Veiga R, Martínez-Cuadrón D, Montesinos P. A systematic review of venetoclax for the treatment of unfit AML patients in real-world: is all that glitters gold? Ann Hematol 2024:10.1007/s00277-024-05891-w. [PMID: 39150561 DOI: 10.1007/s00277-024-05891-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 07/10/2024] [Indexed: 08/17/2024]
Abstract
Acute myeloid leukemia (AML) is an aggressive hematological disease that mainly affects elderly patients. Following the randomized VIALE-A trial, current standard treatment in patients who are not candidates for intensive chemotherapy consists of the combination of venetoclax (VEN), a selective inhibitor of the anti-apoptotic protein BCL-2, with azacitidine (AZA) or decitabine (DEC). We performed a systematic review to critically assess the growing existing evidence regarding the effectiveness of the VEN-based combinations in unfit adult patients with newly diagnosed AML in the real-world setting. Following PRISMA guidelines, a systematic search of published manuscripts and conference abstracts (European Hematology Association and American Society of Hematology) was conducted (updated March 2024). Primary outcomes were composite complete remission (CRc) and median overall survival (mOS). A total of 73 studies fulfilled inclusion criteria, with a median age of 73 years old. The weighted mean mOS was 10.3 months among 7 138 patients, significantly lower than expected according to the VIALE-A trial (14.7 months), while the weighted mean CRc rate was 58.2% among 5 831 patients, slightly lower to that reported in the VIALE-A (66.4%). Early death rates at 30 and 60 days were 5% and 13%, respectively. The weighted mean percentage of subsequent allogeneic transplant was 15.4%. In conclusion, breakthrough mOS reported in the VIALE-A trial using VEN-AZA was not well reproduced in real world for unfit newly diagnosed AML patients, while CRc rates were more consistent. Strategies to optimize patient selection, dosing regimens, and supportive care are crucial to improve outcomes in real-world.
Collapse
Affiliation(s)
- Antonio Solana-Altabella
- Pharmacy Department, Hospital Universitari i Politècnic La Fe, Avenida de Fernando Abril Martorell 106, 46026, Valencia, Spain
- Hematology Department, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Rebeca Rodríguez-Veiga
- Hematology Department, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
- Hematology Department, Hospital Universitari i Politècnic La Fe, Avenida de Fernando Abril Martorell 106, 46026, Valencia, Spain
| | - David Martínez-Cuadrón
- Hematology Department, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
- Hematology Department, Hospital Universitari i Politècnic La Fe, Avenida de Fernando Abril Martorell 106, 46026, Valencia, Spain
| | - Pau Montesinos
- Hematology Department, Hospital Universitari i Politècnic La Fe, Avenida de Fernando Abril Martorell 106, 46026, Valencia, Spain.
- Medicine Department, Universitat de València, Valencia, Spain.
| |
Collapse
|
3
|
Weinbergerová B, Mayer J, Kabut T, Sperr WR, Števková J, Jonášová A, Čerňan M, Herndlhofer S, Oravcová I, Šrámek J, Novák J, Štěpánová R, Szotkowski T, Drgoňa L, Žák P, Valent P. Fungal infection frequency in newly diagnosed acute myeloid leukaemia patients treated with venetoclax plus azacitidine with or without antifungal prophylaxis. Br J Haematol 2024. [PMID: 39044120 DOI: 10.1111/bjh.19670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 07/15/2024] [Indexed: 07/25/2024]
Abstract
Our observational study analysed fungal infection frequency within cohorts with versus without antifungal prophylaxis (AFP) among newly diagnosed first-line venetoclax and azacitidine (VEN + AZA)-treated acute myeloid leukaemias in Czech, Austrian and Slovak haematology centres. Among 186 patients, 85 (46%) received antifungal prophylaxis, while 101 (54%) received no prophylaxis. Fungal infections occurred in 1/85 patients with prophylaxis (1%) and 5/101 patients without prophylaxis (5%) (p = 0.222). No significant difference was recorded between cohorts with and without AFP in terms of death rate (p = 0.296) and overall survival (p = 0.844). In conclusion, most infections were not severe, developing during the first treatment-cycle and did not affect patients' overall outcome.
Collapse
Affiliation(s)
- Barbora Weinbergerová
- Department of Internal Medicine - Hematology and Oncology, Masaryk University and University Hospital Brno, Brno, Czech Republic
| | - Jiří Mayer
- Department of Internal Medicine - Hematology and Oncology, Masaryk University and University Hospital Brno, Brno, Czech Republic
| | - Tomáš Kabut
- Department of Internal Medicine - Hematology and Oncology, Masaryk University and University Hospital Brno, Brno, Czech Republic
| | - Wolfgang R Sperr
- Division of Hematology and Hemostaseology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
| | - Jana Števková
- 4th Department of Internal Medicine-Hematology, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Anna Jonášová
- Medical Department, Hematology, Charles University General Hospital, Prague, Czech Republic
| | - Martin Čerňan
- Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
| | - Susanne Herndlhofer
- Division of Hematology and Hemostaseology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Iveta Oravcová
- Department of Oncohematology, Comenius University and National Cancer Institute, Bratislava, Slovakia
| | - Jiří Šrámek
- Department of Haematology and Oncology, University Hospital Pilsen, Pilsen, Czech Republic
| | - Jan Novák
- Department of Haematology, 3rd Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Radka Štěpánová
- Faculty of Medicine, Center of Excellence CREATIC, Masaryk University, Brno, Czech Republic
| | - Tomáš Szotkowski
- Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
| | - Luboš Drgoňa
- Department of Oncohematology, Comenius University and National Cancer Institute, Bratislava, Slovakia
| | - Pavel Žák
- 4th Department of Internal Medicine-Hematology, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Peter Valent
- Division of Hematology and Hemostaseology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
4
|
Tarantini F, Cumbo C, Anelli L, Zagaria A, Coccaro N, Tota G, Minervini A, Minervini CF, Parciante E, Conserva MR, Redavid I, Specchia G, Musto P, Albano F. Venetoclax-based treatment in acute myeloid leukemia: an unexpected bonus on the path to allogeneic hematopoietic stem cell transplant? Leuk Lymphoma 2024:1-12. [PMID: 39042428 DOI: 10.1080/10428194.2024.2381649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 07/14/2024] [Indexed: 07/24/2024]
Abstract
Despite the approval of new drugs, the inclusion of -omics-derived data and the integration of machine learning in both the diagnostic and therapeutic process, the prognosis of acute myeloid leukemia (AML) remains dismal. The curative path is still aimed at achieving a successful allogeneic hematopoietic stem cell transplant (HSCT) in most patients. Nevertheless, access to this procedure is limited to eligible patients. Moreover, post-HSCT outcomes are influenced by AML heterogeneity and patient-related factors. The rise of venetoclax (VEN)-based combinations as standard of care in the treatment of older or unfit AML patients, together with their peculiar management profile, has led researchers to evaluate the feasibility of this approach in patients proceeding toward HSCT. We reviewed the available evidence to weigh up the advantages and pitfalls of this new therapeutic strategy.
Collapse
Affiliation(s)
- Francesco Tarantini
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J) - Hematology and Stem Cell, Transplantation Unit - University of Bari 'Aldo Moro', Bari, Italy
| | - Cosimo Cumbo
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J) - Hematology and Stem Cell, Transplantation Unit - University of Bari 'Aldo Moro', Bari, Italy
| | - Luisa Anelli
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J) - Hematology and Stem Cell, Transplantation Unit - University of Bari 'Aldo Moro', Bari, Italy
| | - Antonella Zagaria
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J) - Hematology and Stem Cell, Transplantation Unit - University of Bari 'Aldo Moro', Bari, Italy
| | - Nicoletta Coccaro
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J) - Hematology and Stem Cell, Transplantation Unit - University of Bari 'Aldo Moro', Bari, Italy
| | - Giuseppina Tota
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J) - Hematology and Stem Cell, Transplantation Unit - University of Bari 'Aldo Moro', Bari, Italy
| | - Angela Minervini
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J) - Hematology and Stem Cell, Transplantation Unit - University of Bari 'Aldo Moro', Bari, Italy
| | - Crescenzio Francesco Minervini
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J) - Hematology and Stem Cell, Transplantation Unit - University of Bari 'Aldo Moro', Bari, Italy
| | - Elisa Parciante
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J) - Hematology and Stem Cell, Transplantation Unit - University of Bari 'Aldo Moro', Bari, Italy
| | - Maria Rosa Conserva
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J) - Hematology and Stem Cell, Transplantation Unit - University of Bari 'Aldo Moro', Bari, Italy
| | - Immacolata Redavid
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J) - Hematology and Stem Cell, Transplantation Unit - University of Bari 'Aldo Moro', Bari, Italy
| | | | - Pellegrino Musto
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J) - Hematology and Stem Cell, Transplantation Unit - University of Bari 'Aldo Moro', Bari, Italy
| | - Francesco Albano
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J) - Hematology and Stem Cell, Transplantation Unit - University of Bari 'Aldo Moro', Bari, Italy
| |
Collapse
|
5
|
Chatzilygeroudi T, Darmani I, El Gkotmi N, Vryttia P, Douna S, Bouchla A, Labropoulou V, Kotsopoulou M, Symeonidis A, Pagoni M, Pappa V, Papageorgiou SG. Real-Life Multicenter Experience of Venetoclax in Combination with Hypomethylating Agents in Previously Untreated Adult Patients with Acute Myeloid Leukemia in Greece. J Clin Med 2024; 13:584. [PMID: 38276092 PMCID: PMC10816211 DOI: 10.3390/jcm13020584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/15/2024] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND The landscape of first-line treatment for acute myeloid leukemia (AML) patients ineligible for intensive chemotherapy has changed remarkably after venetoclax approval. Accumulating real-world data further apprises us with more knowledgeable use. To assess the efficacy and safety challenges in the real-life setting of the combination of hypomethylated agent (HMA) and venetoclax, we conducted a multi-center retrospective study. METHODS Forty adult AML patients treated with the combination of HMA and venetoclax as a first-line treatment after full approval (2020) were included. To confirm VIALE-A results, this group was compared to a historical cohort of 17 chemotherapy-ineligible AML patients treated with HMA monotherapy before 2020. RESULTS The combination of HMA-venetoclax achieved a composite complete response rate of 86.8% (p < 0.001), median overall survival, and event-free survival of 33.8 and 19.7 months, respectively, in a median follow-up of 17.8 months (pos < 0.001, HR = 0.276, CI: 0.132-0.575, pEFS = 0.004, HR = 0.367, CI: 0.174-0.773). High rates of neutropenia (90%) and consequent infection rates (57.5%) were noted. Only 55% of our patients received antifungal prophylaxis, as its use remains controversial, and invasive fungal infections were presented in 7.5%. CONCLUSIONS Evidently, venetoclax-HMA yields high response rates and profound survival benefits in real life and has changed our approach to alternative chemotherapy options.
Collapse
Affiliation(s)
- Theodora Chatzilygeroudi
- Hematology Division, Department of Internal Medicine, School of Health Sciences, Faculty of Medicine, University of Patras, 30100 Patras, Greece; (T.C.); (V.L.); (A.S.)
| | - Ismini Darmani
- Hematology Department, Evaggelismos General Hospital, 10676 Athens, Greece; (I.D.); (N.E.G.); (M.P.)
| | - Natali El Gkotmi
- Hematology Department, Evaggelismos General Hospital, 10676 Athens, Greece; (I.D.); (N.E.G.); (M.P.)
| | - Pinelopi Vryttia
- Hematology Unit, Second Department of Internal Medicine, and Research Institute, Medical School, University General Hospital “Attikon”, National and Kapodistrian University of Athens, 12462 Athens, Greece; (P.V.); (A.B.); (V.P.)
| | - Stavroula Douna
- Hematology Department, Metaxa General Hospital, 18537 Peiraeus, Greece; (S.D.); (M.K.)
| | - Anthi Bouchla
- Hematology Unit, Second Department of Internal Medicine, and Research Institute, Medical School, University General Hospital “Attikon”, National and Kapodistrian University of Athens, 12462 Athens, Greece; (P.V.); (A.B.); (V.P.)
| | - Vasiliki Labropoulou
- Hematology Division, Department of Internal Medicine, School of Health Sciences, Faculty of Medicine, University of Patras, 30100 Patras, Greece; (T.C.); (V.L.); (A.S.)
| | - Maria Kotsopoulou
- Hematology Department, Metaxa General Hospital, 18537 Peiraeus, Greece; (S.D.); (M.K.)
| | - Argiris Symeonidis
- Hematology Division, Department of Internal Medicine, School of Health Sciences, Faculty of Medicine, University of Patras, 30100 Patras, Greece; (T.C.); (V.L.); (A.S.)
| | - Maria Pagoni
- Hematology Department, Evaggelismos General Hospital, 10676 Athens, Greece; (I.D.); (N.E.G.); (M.P.)
| | - Vasiliki Pappa
- Hematology Unit, Second Department of Internal Medicine, and Research Institute, Medical School, University General Hospital “Attikon”, National and Kapodistrian University of Athens, 12462 Athens, Greece; (P.V.); (A.B.); (V.P.)
| | - Sotirios G. Papageorgiou
- Hematology Unit, Second Department of Internal Medicine, and Research Institute, Medical School, University General Hospital “Attikon”, National and Kapodistrian University of Athens, 12462 Athens, Greece; (P.V.); (A.B.); (V.P.)
| |
Collapse
|